Patient trying to tell something else: severe stress during COVID-19 pandemic

• Main Authors: Abdullah, Fa’iza, Mohd Razib, Mohd Zhafri, Mat Nor, Mohd Basri
• Format: Article
• Language: English
• Published: Kulliyyah of Nursing, International Islamic University Malaysia 2022
• Subjects: R Medicine (General); RA Public aspects of medicine; RB Pathology
• Online Access: http://irep.iium.edu.my/96722/7/96722_Patient%20trying%20to%20tell%20something%20else%20severe%20stress.pdf; http://irep.iium.edu.my/96722/; https://journals.iium.edu.my/ijcs/index.php/ijcs/article/view/237/123

Identifying mental health illness poses a dilemma, particularly the distinction between heart disease and severe stress. Without early intervention, it can escalate into psychiatric disorder and suicide. A 44-year-old man sought cardiologist consultation for the "heart disease" symptoms. As a medical laboratory technician in charge, his commitments and extensive responsibility during the COVID-19 pandemic add to his hypertension and dyslipidaemia comorbidities. Despite non-significant investigations related to heart disease, he returned with the same intense unresolved symptoms. His Depression Anxiety Stress Scales 21-item assessment revealed severe stress. Stress management counselling includes detecting the underlying stress impacted by the COVID-19 pandemic, behavioural changes, and stress coping skills was done in 4 sessions. The 1st one-hour session was to instil positive thinking and behavioural changes of the severe underlying stress and to counsel the stress coping skills. Stress coping skill includes relaxation techniques (Deep Breathing Technique and Progressive Relaxation Method) and spiritual empowerment (Islamic Integrated Meditation). The next three counselling sessions of thirty minutes duration to heighten the stress management counselling (positive thinking, stress coping skills, spiritual empowerment) as well as to review his wellbeing and physical diseases control were done at two-week interval. At twelve-week follow-up, reassessment of stress level showed significant improvement with no similar symptoms. This case highlights the clinical complexity and diagnostic challenges in detecting mental health illness. Diagnostic acronym PROMPT with the 'PT' refers to 'Patient Trying to Tell Something Else' demonstrated; without a high index of suspicion, mental health ailment may be overlooked. This case also underlined the integration of behavioural changes, stress coping skills, and spiritual empowerment in stress management counselling.